Dr. Rayna Stoyanova for Mediapool: New weight loss therapies are powerful tools, but harmful when used alone

Medication is not some “magic wand”, it only works if we change our habits too. New weight loss therapies from GLP-1 agonist group are especially effective when it comes to fighting obesity. However, when applied arbitrarily and incompetently, as we see happens often, they can carry serious health risks. This is what Dr. Rayna Stoyanova, endocrinologist and part of the Regina Life Clinic team, told Mediapool. She says that medicine is not a “magic wand” and only works effectively when a change is made in our daily habits.

“Patients who have taken such medications, that have severe side effects that are difficult to treat, often come to us” she points out. Dr. Stoyanova says it is important for people who are overweight to start their treatment under the guidance of a specialist from the very beginning. Because patients who have gone through multiple diets and “yo-yo” dieting have the slowest metabolism and find it the most difficult to lose weight.

New treatments for diabetes and weight loss

Recently, Ozempic – medication for treatment of type 2 diabetes in adults, which is highly in demand due to its use as a weight loss drug, has become popular in our country. Ozempic is from the GLP-1 group and is prescribed to patients with type 2 diabetes, used once a week, one of its effects is weight loss, explains Dr. Stoyanova.
“This product should not be used for weight loss and bought off-label by patients. Because of its popularity, people who do not medically need weight loss have been using it” she said. There is a similar product on the market from the same group, which is approved in Bulgaria and Europe only for weight loss: liraglutide – with the brand name Saxenda.

“The difference between Saxenda and Ozempic, is that Saxenda is taken every day and Ozempic – once a week. This easier way of taking Ozempic once a week causes a lot of interest, even when people don’t really need it. Infusion therapies, so-called weight loss drips, in which this type of medication is added are also gaining popularity. A lot of people are becoming fans of these products,” says Dr. Stoyanova.

Side effects

According to her, it is necessary to be very careful when prescribing medication that has side effects. “Patients who have taken such medications that have severe side effects and are very difficult to treat often come to us” she said. Dr. Stoyanova points out that when used correctly, the benefits of this type of treatment are numerous both in terms of cardiovascular health and overall risk of mortality.

“The mechanism of this type of GLP-1 agonists drugs is associated with several side effects that involve the gastrointestinal tract and the brain. They can cause nausea, vomiting, especially when having an improper diet: overeating fatty food. In some patients, this effect can be very intense at the beginning, but it is treatable. Tachycardia and constipation can occur in patients with poor hydration. Problems with the central nervous system can also occur due to appetite suppression. Appetite suppression means that patients do not eat regularly and hence fainting, flushing and headaches can be experienced” explains Dr Stoyanova.

There’s also a new study that talks about “Ozempic face,” a symptom of skin aging. “Skin starts sagging because of weight loss and skin’s elasticity decreases. If we don’t hydrate properly, we may end up with more sagging and wrinkled skin. This is the so-called ‘Ozempic face’, but it can be overcome if the patient follows the advice given by the doctor. Again, it comes down to the fact that the drug must be prescribed by an endocrinologist; the patient has to meet the criteria and must be given proper treatment for the therapy to work well” she points out.

Is this therapy suitable for everyone?

Almost every person who struggles with overweight is suitable for treatment with GLP-1 agonists, which are revolutionary in the treatment of obesity and overweight. “The earlier the treatment is started, the better” says Dr. Stoyanova.

Not every patient with diabetes is suitable for treatment with GLP-1 agonists, it is effective for patients with type 2 diabetes mellitus – non-insulin-dependent patients. According to the latest treatment guidelines, patients can start treatment with this drug if they do not have impaired pancreatic function, explains Dr. Stoyanova. However, because the therapy is expensive, NHIS requires to take some other steps first before going on it. “Overall, the therapy is good, appropriate, and has outstanding benefits in terms of cardiovascular health and overall patient mortality” she comments.

It is not a magical cure, it only works when change in habits is made

Not all patients are as equally affected by the drug. According to recent studies, 7 out of 10 patients lose weight, and 3 out of 10 do not lose much or do not lose weight at all. Many patients cannot handle the side effects. At the same time, many do not feel any side effects at all. “If this therapy does not work it can be combined with other drugs, one can switch to another treatment. But it is not a magic wand, it only works with a lot of lifestyle changes. GLP-1 agonists affect centers in the brain that are linked to bad habits: apart from addiction to sugary foods, etc. That is why when a patient is treated with this type of medicine, is the perfect time to change their lifestyle to a healthier one and when the treatment comes to an end, the healthy habits remain and the weight loss could be maintained for a longer time”, explains Dr. Stoyanova.

“Studies have shown that patients who are on therapy and have changed their habits have much better results than those who have only changed habits. So, medications play their role, but we must follow the advice of specialists,” she points out.

People with a long history of dieting find it hardest to lose weight

Dr. Stoyanova points out that obesity is a chronic disease like hypertension and asthma and should be treated as such. Treatment should begin at an early stage to avoid complications that can be fatal. When weight is being lost in a healthy way, the effect can be maintained longer and the patients are more motivated, she says.

“Any spontaneous decision to lose weight in an unhealthy way leads to fat loss, but also muscle mass. When we gain weight, there is a yo-yo effect – we start to put the weight back on, but we put fat back on, not muscle mass. This results in a slower metabolism because it’s the muscles that burn calories. Training our muscles is what burns calories. That’s why patients with a long history of dieting are the most difficult cases. They are the people with the slowest metabolism and it’s very difficult for them to lose weight” says Dr. Stoyanova.

That is why it is important to start on the right path from the very beginning under the guidance of a specialist.

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